Saladin: Anatomy & Physiology: The Unity of Form and Function, Third Edition

Front Matter

Clinical Emphasis

The McGrawHill Companies, 2003

Anatomy and Physiology is fundamentally a textbook of the basic science of the human body. However, students always want to know why all the science is relevant to their career aims. Clinical examples and thought questions make it so. Students can see how the science relates to well-known dysfunctions, and why it is important to know the basics. Dysfunctions also provide windows of insight into the basic concepts, such as the insight that cystic fibrosis gives on the importance of membrane ion channels, or that antidepressants give on the synaptic reuptake of neurotransmitters.
Chapter 11

436 Part Two Support and Movement Smooth muscle exhibits a reaction called the stressrelaxation (or receptive relaxation) response. When stretched, it briefly contracts and resists, but then relaxes. The significance of this response is apparent in the urinary bladder, whose wall consists of three layers of smooth muscle. If the stretched bladder contracted and did not soon relax, it would expel urine almost as soon as it began to fill, thus failing to store the urine until an opportune time. Remember that skeletal muscle cannot contract very forcefully if it is overstretched. Smooth muscle is not subject to the limitations of this length-tension relationship. It must be able to contract forcefully even when greatly stretched, so that hollow organs such as the stomach and bladder can fill and then expel their contents efficiently. Skeletal muscle must be within 30% of optimum length in order to contract strongly when stimulated. Smooth muscle, by contrast, can be anywhere from half to twice its resting length and still contract powerfully. There are three reasons for this: (1) there are no Z discs, so thick filaments cannot butt against them and stop the contraction; (2) since the thick and thin filaments are not arranged in orderly sarcomeres, stretching of the muscle does not cause a situation where there is too little overlap for crossbridges to form; and (3) the thick filaments of smooth muscle have myosin heads along their entire length (there is no bare zone), so cross-bridges can form anywhere, not just at the ends. Smooth muscle also exhibits plasticity the ability to adjust its tension to the degree of stretch. Thus, a hollow organ such as the bladder can be greatly stretched yet not become flabby when it is empty. The muscular system suffers fewer diseases than any other organ system, but several of its more common dysfunctions are listed in table 11.6. The effects of aging on the muscular system are described on pages 11091110.

Before You Go On
Answer the following questions to test your understanding of the preceding section: 25. Explain why intercalated discs are important to cardiac muscle function. 26. Explain why it is important for cardiac muscle to have a longer action potential and longer refractory period than skeletal muscle. 27. How do single-unit and multiunit smooth muscle differ in innervation and contractile behavior? 28. How does smooth muscle differ from skeletal muscle with respect to its source of calcium and its calcium receptor? 29. Explain why the stress-relaxation response is an important factor in smooth muscle function.

There are many tidbits of clinical information that are in this book, but not in others that I have seen. I think thats great! I have learned a thing or two. I also think that the author has tried to choose clinical examples that are commonly dealt with and therefore most useful to the student. L. Steele, Ivy Tech State College

Table 11.6 Some Disorders of the Muscular System

Delayed onset muscle soreness Cramps Contracture Fibromyalgia Pain, stiffness, and tenderness felt from several hours to a day after strenuous exercise. Associated with microtrauma to the muscles, with disrupted Z discs, myofibrils, and plasma membranes; and with elevated levels of myoglobin, creatine kinase, and lactate dehydrogenase in the blood. Painful muscle spasms triggered by heavy exercise, extreme cold, dehydration, electrolyte loss, low blood glucose, or lack of blood flow. Abnormal muscle shortening not caused by nervous stimulation. Can result from failure of the calcium pump to remove Ca2 from the sarcoplasm or from contraction of scar tissue, as in burn patients. Diffuse, chronic muscular pain and tenderness, often associated with sleep disturbances and fatigue; often misdiagnosed as chronic fatigue syndrome. Can be caused by various infectious diseases, physical or emotional trauma, or medications. Most common in women 30 to 50 years old. A shocklike state following the massive crushing of muscles; associated with high and potentially fatal fever, cardiac irregularities resulting from K released from the muscle, and kidney failure resulting from blockage of the renal tubules with myoglobin released by the traumatized muscle. Myoglobinuria (myoglobin in the urine) is a common sign. Reduction in the size of muscle fibers as a result of nerve damage or muscular inactivity, for example in limbs in a cast and in patients confined to a bed or wheelchair. Muscle strength can be lost at a rate of 3% per day of bed rest. Muscle inflammation and weakness resulting from infection or autoimmune disease. Hernia p. 351 Muscular dystrophy p. 437 Myasthenia gravis p. 437 Paralysis p. 414 Pitchers arm p. 386 Pulled groin p. 386 Pulled hamstrings p. 386 Rotator cuff injury p. 386 Tennis elbow p. 386 Tennis leg p. 386

Crush syndrome

Disuse atrophy Myositis Disorders described elsewhere Athletic injuries p. 386 Back injuries p. 349 Baseball finger p. 386 Carpal tunnel syndrome p. 365 Charley horse p. 386 Compartment syndrome p. 386

Pathology Tables For each organ system, Saladin presents a table that briefly describes several wellknown dysfunctions and comprehensively lists the pages where students can find comments on other disorders of that system.

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Saladin: Anatomy & Physiology: The Unity of Form and Function, Third Edition

Front Matter

Clinical Emphasis

The McGrawHill Companies, 2003

Chapter 10 The Muscular System 351

I like Saladins presentation because I feel an understanding of how medicine and science have changed throughout history is part of becoming a "well educated," not just a "well trained" student. - R. Pope, Miami-Dade Community College

Superior nuchal line Semispinalis capitis Semispinalis cervicis

Longissimus capitis Splenius capitis

Serratus posterior superior

Splenius cervicis Erector spinae Iliocostalis Longissimus Spinalis Serratus posterior inferior Chapter 10 Multifidus Internal abdominal oblique External abdominal oblique (cut) Quadratus lumborum Semispinalis thoracis

Clinical Applications Each chapter has three to five Insight boxes, many of which are clinical in nature. These essays illuminate the clinical relevance of a concept and give insight on disease as it relates to normal structure and function.

Figure 10.18 Muscles Acting on the Vertebral Column. Those on the right are deeper than those on the left.

erection. In males, the bulbospongiosus (bulbocavernosus) forms a sheath around the base (bulb) of the penis; it expels semen during ejaculation. In females, it encloses the vagina like a pair of parentheses and tightens on the penis during intercourse. Voluntary contractions of this muscle in both sexes also help void the last few milliliters of urine. The superficial transverse perineus extends from the ischial tuberosities to a strong central tendon of the perineum. In the middle compartment, the urogenital triangle is spanned by a thin triangular sheet called the urogenital diaphragm. This is composed of a fibrous membrane and two musclesthe deep transverse perineus and the external urethral sphincter (fig. 10.20c, d). The anal triangle contains the external anal sphincter. The deepest compartment, called the pelvic diaphragm, is similar in both sexes. It consists of two muscle pairs shown in figure 10.20ethe levator ani and coccygeus.

Insight 10.3
Hernias

Clinical Application

The accuracy of information in this text is as good as it gets. Saladin seems to be right on top of every new bit of information that is revealed. What I really like about the Saladin text is that it lets students know when we dont know why something is the way it is. Other texts will try to make the facts fit when they actually dont. W. Schmidt, Palm Beach Community College

A hernia is any condition in which the viscera protrude through a weak point in the muscular wall of the abdominopelvic cavity. The most common type to require treatment is an inguinal hernia. In the male fetus, each testis descends from the pelvic cavity into the scrotum by way of a passage called the inguinal canal through the muscles of the groin. This canal remains a weak point in the pelvic floor, especially in infants and children. When pressure rises in the abdominal cavity, it can force part of the intestine or bladder into this canal or even into the scrotum. This also sometimes occurs in men who hold their breath while lifting heavy weights. When the diaphragm and abdominal muscles contract, pressure in the abdominal cavity can soar to 1,500 pounds per square inchmore than 100 times the normal pressure and quite sufficient to produce an inguinal hernia, or rupture. Inguinal hernias rarely occur in women.

Saladin: Anatomy & Physiology: The Unity of Form and Function, Third Edition

Front Matter

Clinical Emphasis

The McGrawHill Companies, 2003

Interactions Between the RESPIRATORY SYSTEM and Other Organ Systems

indicates ways in which this system affects other systems indicates ways in which other systems affect this one

Connective Issues The human organ systems do not exist in isolation from each other. Diseases of the circulatory system can lead to failure of the urinary system and aging of the skin can lead to weakening of the skeleton. For each organ system, a page called Connective Issues shows how it affects other systems of the body and is affected by them.

All Systems
The respiratory system serves all other systems by supplying O2, removing CO2, and maintaining acid-base balance

Integumentary System
Nasal guard hairs reduce inhalation of dust and other foreign matter

Skeletal System
Thoracic cage protects lungs; movement of ribs produces pressure changes that ventilate lungs

Muscular System
Skeletal muscles ventilate lungs, control position of larynx during swallowing, control vocal cords during speech; exercise strongly stimulates respiration because of the CO2 generated by active muscles
Chapter 22

Nervous System
Produces the respiratory rhythm, monitors blood gases and pH, monitors stretching of lungs; phrenic, intercostal, and other nerves control respiratory muscles

Endocrine System
Lungs produce angiotensin-converting enzyme (ACE), which converts angiotensin I to the hormone angiotensin II Epinephrine and norepinephrine dilate bronchioles and stimulate ventilation

858 Part Four Regulation and Maintenance This section describes the neural mechanisms that regulate pulmonary ventilation. Neurons in the medulla oblongata and pons provide automatic control of unconscious breathing, whereas neurons in the motor cortex of the cerebrum provide voluntary control.

Circulatory System
Regulates blood pH; thoracic pump aids in venous return; lungs produce blood platelets; production of angiotensin II by lungs is important in control of blood volume and pressure; obstruction of pulmonary circulation leads to right-sided heart failure Blood transports O2 and CO2; mitral stenosis or left-sided heart failure can cause pulmonary edema; emboli from peripheral sites often lodge in lungs

Urinary System
Valsalva maneuver aids in emptying bladder Disposes of wastes from respiratory organs; collaborates with lungs in controlling blood pH

Digestive System
Valsalva maneuver aids in defecation Provides nutrients for growth and maintenance of respiratory system

Control Centers in the Brainstem

The medulla oblongata contains inspiratory (I) neurons, which fire during inspiration, and expiratory (E) neurons, which fire during forced expiration (but not during eupnea). Fibers from these neurons travel down the spinal cord and synapse with lower motor neurons in the cervical to thoracic regions. From here, nerve fibers travel in the phrenic nerves to the diaphragm and intercostal nerves to the intercostal muscles. No pacemaker neurons have been found that are analogous to the autorhythmic cells of the heart, and the exact mechanism for setting the rhythm of respiration remains unknown despite intensive research. The medulla has two respiratory nuclei (fig. 22.15). One of them, called the inspiratory center, or dorsal respiratory group (DRG), is composed primarily of I neurons, which stimulate the muscles of inspiration. The more frequently they fire, the more motor units are recruited and the more deeply you inhale. If they fire longer than usual, each breath is prolonged and the respiratory rate is slower. When they stop firing, elastic recoil of the lungs and thoracic cage produces passive expiration. The other nucleus is the expiratory center, or ventral respiratory group (VRG). It has I neurons in its midregion and E neurons at its rostral and caudal ends. It is not involved in eupnea, but its E neurons inhibit the inspiratory center when deeper expiration is needed. Conversely, the inspiratory center inhibits the expiratory center when an unusually deep inspiration is needed. The pons regulates ventilation by means of a pneumotaxic center in the upper pons and an apneustic (apNEW-stic) center in the lower pons. The role of the apneustic center is still unclear, but it seems to prolong inspiration. The pneumotaxic (NEW-mo-TAX-ic) center sends a continual stream of inhibitory impulses to the inspiratory center of the medulla. When impulse frequency rises, inspiration lasts as little as 0.5 second and the breathing becomes faster and shallower. Conversely, when impulse frequency declines, breathing is slower and deeper, with inspiration lasting as long as 5 seconds.

Pons Medulla

Excitation Inhibition

Lymphatic/Immune Systems
Thoracic pump promotes lymph flow Lymphatic drainage from lungs is important in keeping alveoli dry; immune cells protect lungs from infection

Reproductive System
Valsalva maneuver aids in childbirth Sexual arousal stimulates respiration

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Pneumotaxic center

Apneustic center

Expiratory center

Inspiratory center

Chapter 22

The clinical application approach seems much more consistently and richly in evidence in Saladin. - D. Plantz, Mohave Community College

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Internal intercostal muscles External intercostal muscles Diaphragm

Think About It
Do you think the fibers from the pneumotaxic center produce EPSPs or IPSPs at their synapses in the inspiratory center? Explain.

Figure 22.15 Respiratory Control Centers. Functions of the apneustic center are hypothetical and its connections are therefore indicated by broken lines. As indicated by the plus and minus signs, the apneustic center stimulates the inspiratory center, while the pneumotaxic center inhibits it. The inspiratory and expiratory centers inhibit each other.

quency rises, inspiration lasts as little as 0.5 second and the breathing becomes faster and shallower. Conversely, when impulse frequency declines, breathing is slower and deeper, with inspiration lasting as long as 5 seconds.

Think About It
Do you think the fibers from the pneumotaxic center produce EPSPs or IPSPs at their synapses in the inspiratory center? Explain.

Think About It Success in health professions requires far more than memorization. More important is your insight and ability to apply what you remember in new cases and problems. Think About It questions, which can be found strategically distributed throughout each chapter, encourage stopping and thinking more deeply about the meaning or broader significance.